Unusual accelerated progression of saccular aneurysms in an ectatic right coronary artery

Localized aneurysmal dilation or ectasia of coronary arteries is a relatively uncommon angiographic finding, of which the pathophysiological mechanism remains speculative. The majority of patients diagnosed with this clinical entity usually present with angina pectoris. Furthermore, it is rare to find isolated ectasia or aneurysm dilation of the coronary arteries in patients with no prior history of coronary artery disease. The natural course is usually slowly progressive. This case demonstrates an unusual accelerated dilation of coronary saccular aneurysms, within a year of diagnosis, in a patient who presented with new onset congestive heart failure. Although the diagnosis was made with coronary angiography, both magnetic resonance imaging and transesophageal echocardiography were of critical diagnostic value to identify the size and extension of the aneurysms as well as the presence of intraluminal thrombi.